NI PIP Handbook - Assessment Process and Assessment Provider

Part of: Northern Ireland PIP Handbook

The PIP assessment will be delivered by an Assessment Provider working on our behalf, behalf of the Department for Communities and could either be by pre-arranged phone call; face to face or for some claims by paper based claim.

Sometimes we the Department can make a decision by using just the written information a claimant sends us but some people may be asked to go to a consultation with a health professional.

The consultation will be conducted by a health professional who considers the evidence provided by the claimant, along with any further evidence they think is needed.

The assessment looks at people as individuals, and focuses on the impact their condition has on their daily lives and over a range of different activities.

The health professional will complete the assessment and will send a report back to us. A PIP Case Manager will then use all of this information to decide entitlement to PIP. The health professional will not make a decision on entitlement to PIP.

The consultation

The consultation may take place at a designated consultation centre, or in the claimant’s own home or over the phone.

The claimant will be encouraged to have someone with them at the consultation to support them and participate in the discussion if they would find this useful.

The person chosen is at the discretion of the claimant and might be, but is not limited to, a parent, family member, friend, carer or someone else who can speak on the claimant’s behalf. If it is clear that the claimant requires more than one person to accompany them to enable them to attend a consultation, this should be identified as part of the booking process. The assessment provider may decide that the claimant would benefit from a home visit rather than a designated consultation centre if they require multiple people to assist them to attend the consultation.

We have asked the Assessment Provider to ensure that claimants travel no more than 90 minutes (single journey) by public transport to their consultations. This figure is an absolute maximum and it is expected that travel time will be far less for the majority of cases.

Home consultations will take place:

  • at the claimant’s request, if supported by an appropriate health condition or disability, as determined by the Assessment Provider, or
  • when the claimant provides confirmation through their health professional that they are unable to travel on health grounds, or
  • at the Assessment Provider’s discretion for a business reason.

At the consultation, the health professional will ask questions about the claimant’s circumstances, their health condition or disability and how this affects their daily life.

The health professional may also carry out a short physical examination, but claimants will not be forced to do anything that causes them pain, embarrassment or discomfort.

The Assessment Provider will ensure that the health professional have the right skills and experience to assess any claimant referred to them. The claimant can have someone with them for support and they can take part in the discussion too.

We believe that in most cases all health professionals should be able to assess the individual, even if they are not a specialist in their condition.

If the health professional feels they need more support before assessing someone, for example because the claimant has a condition, they are unfamiliar with, the Assessment Provider will make someone with the appropriate skills available to either assist the original health professional or carry out the assessment themselves.

There is no time limit for consultations. Consultations will be as long as necessary to reach the evidence-based conclusions on individual cases. The assessment can be recorded, and the claimant can ask for a copy of the assessment report. The invitation letter the claimant receives advises how to request their assessment is recorded.

The Assessment Provider and their role

In Northern Ireland the PIP Assessment Provider will be Capita Health and Wellbeing.

How assessments are carried out is governed by regulations and guidance. Everyone will be able to bring a companion, see a same sex assessor if they advise the Assessment Provider in advance, and claim back their travel expenses. The health professional will be recruited for their empathy as well as medical qualifications. The health professional will encourage claimants to explain how they feel on a bad day as well as on a good day. They will provide advice to us – we make the decision about entitlement to PIP.

For information about Capita Health and Wellbeing. Please visit Capita.

Managing performance

We will monitor the performance of the Assessment Provider to make sure they are conforming to the detailed specifications for the assessment laid out in their contract with us.

We have set clear service level agreements setting out expectations for service delivery, including the quality of assessments and, the number of days to provide advice to us and evidence of claimant satisfaction. We have not set any targets in relation to the outcome of PIP assessments. This will ensure all the assessments are consistent, fair, evidence based and delivered to the required quality standard.

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